Tony Plakas: Stereotypes were always a barrier in fight against AIDS

November 28, 2012|Tony Plakas

After 30 years, the fight against AIDS has turned an important corner. A week ago, a task force which advises the U.S. government on preventative medicine proposed doctors offer HIV tests to all people ages 15 to 64. Prior recommendations suggested physicians offer tests to those who are at a heightened risk for contracting HIV because of their sexual behaviors, an imperative impeded by many years of bias and stigma.

Canadian doctors, in the Canadian Medical Assn. Journal, echoed this advice, citing "a 20 year-old diagnosed and then treated with cocktails of antiretroviral drugs can expect to live to age 73 because of the benefits of early detection."

Additionally, doctors reported "people who know they are infected will often change their behavior toward less risky practices -- and when HIV-positive people are treated with antiretroviral drugs --the HIV counts in their bodies fall dramatically and transmission of the virus to uninfected partners drops more than 95 percent."

These recommendations bring together what we know scientifically with what we've known anecdotally for quite some time. Since 1995, when protease inhibitors essential to antiretroviral treatments came out of clinical trials, those of us working in the field of HIV knew HIV could be managed if detected early enough. What is baffling is it took so long to put into practice what we've known about the progression of this disease for more than 15 years.

Back in the late 90's, states were wrestling with new laws related to informed consent for HIV testing and mandatory reporting of people known to have contracted HIV. Just the thought that someone might find out another was tested for HIV invoked fears of discrimination, anxieties related to potential loss of health insurance, and an overall fear of being cast aside and classified as an IV drug user, sex worker or homosexual. Since that time, popular culture has played a large role in the uphill battle against our initial responses to HIV.

Canadian doctors recently acknowledged, "HIV meets the widely accepted principles for screening programs. Its treatment is accepted, accessible and highly cost-effective; its screening is sensitive, specific and minimally invasive; and its early treatment has been well established as beneficial…it is therefore imperative to implement and evaluate routine HIV testing across Canada." Lives would have been saved, and the quality of life for countless others enhanced, had we not needed scientific proof to make popular what was already known. We used labels to provide many with false comfort, and we clung to those labels for our own protection.

For many, for a long time, HIV wasn't just a possibility; it was inevitability. HIV was a certainty because of who someone was. Now we've lost a generation of people who would have avoided suffering if only we were willing to have hard conversations, and had faith in what science was willing to reveal to us. The human factor has been the most difficult factor to face in the fight against the transmission of HIV.

As we approach World AIDS Day this Saturday, we can celebrate progress and acknowledge how far we've moved from the dark ages of AIDS. We will remember those we've lost and the loved ones we've saved, but we can never ignore the fact that stereotypes have always been the principle barrier in this battle. The barrier isn't a technological one; it isn't a scientific one; it is a human one. We built the barriers ourselves, and we've remained comfortable within the walls we built.

History will prove the ideas associated with HIV were more infectious than the transmission of the virus itself, and that misinformation and miscommunication played a vicious role in advancing the spread of the virus. These new steps in public policy are great steps in the right direction - but when we write the story of "How AIDS Ends," we will know the advanced steps we've taken were on the wrong side of the history of AIDS.